| NPI | 1770750325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 8397) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MI E22) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |